ORIF Proximal Humerus Fracture

An open reduction internal fixation for a proximal humerus fracture involves making about an 8-10 cm incision in the front of the shoulder. The fracture is visualized and the bone fragments are put back in place. A metal plate with screws are inserted to bridge the bony fragments and secure them in place to allow the bone to heal in good alignment.

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An approximately 8-10 cm incision is made over the front of the shoulder. The fracture pieces are identified and brought into a more anatomic position. A plate is fixated to the bone to support the fracture while the bone is healing. Fluoroscopy (X-ray beam) is used to confirm anatomic position of the pieces. The incision is then closed with absorbable sutures, and dressings are applied. The patient will wake up with a sling in place. 

  • This surgery is performed under general anesthesia with a nerve block.
  • This surgery is usually outpatient, which means the patient generally goes home the day of surgery.
  • Surgery typically lasts 1-1.5 hours.
  • A sling will be fit at a preop appointment before surgery and will need to brought to surgery.
  • The sling will be placed on the patient prior to waking up from anesthesia.
  • The incisions will be closed with absorbable sutures, and a waterproof dressing will be applied. This should be left in place until the first postop appointment.
  • The patient may shower right away as long as there is a good seal of the waterproof dressing. 

Frequently Asked


How long will I need to wear my sling?

4 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed.

Can I drive with a sling on?

You can drive when you feel safe to operate a vehicle with 1 functioning arm. This usually takes most patients a few weeks after surgery.

Do I have to wear the sling at night?

Yes. Patients are usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.

When do I start PT after surgery?

Physical therapy typically starts 2 weeks after surgery.

When can I shower?

2 days after surgery. You will have a waterproof dressing on that should be left in place until your first postoperative appointment.

How often do I need to use the ice machine?

The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.

What is a nerve block?

An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.

How can I control my pain after surgery?

This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, you may be encouraged to take anti-inflammatories and Tylenol instead of the narcotics.

What are the risks of open reduction internal fixation of my proximal humerus fracture?

The overall risk of a complication is less than 1%. The most common risk is shoulder stiffness from scarring. Other more rare risks include, shifting of the fracture (malunion) causing screws to damage the cartilage, infection, bleeding, and painful hardware.

I am told I need surgery. What next?